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冠動脈疾患の主なリスク要因の重要度
Michael J Pencina1, Ann Marie Navar1, Daniel Wojdyla1
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.).
Circulation
|December 28, 2018
まとめ
高血圧やコレステロールなどの主要な冠動脈疾患 (CHD) リスク因子を制御すると,予後モデルにわずかに追加しても,CHDの発生を大幅に減少させます. リスク因子評価の調整は 効果的な予防戦略に不可欠です
科学分野:
- 心血管疾患の研究
- 予防 医療
- 流行病学
背景:
- 冠動脈疾患 (CHD) の予防を最適化するには,主要な危険因子の影響を定量化する必要があります.
- 変更可能な危険因子には,脂質,シストリック血圧 (SBP),糖尿病,喫煙が含まれます.
研究 の 目的:
- 修正可能なCHDリスク要因とインシデントCHDイベントの関連を比較する.
- 年齢による予後効果,リスク分数,治療効果の評価.
主な方法:
- 国立心臓,肺,血液研究所による4つの観察コホート研究から得られた参加者レベルのデータをまとめました.
- 初めは心臓血管疾患のない45歳から84歳の22,626人を10年間追跡した.
- モデル性能,ハザード比,および集団による分数を推定するために,比例したハザード回帰を用いた.
主要な成果:
- 年齢,性別,人種が予後能力の63-80%を説明し,SBP,非HDL-C,糖尿病,または喫煙を追加すると,わずかな増加 (C指数0.004-0.013) が得られた.
- SBP ≥130 mm Hgでは28%,非HDL-C ≥130 mg/ dLでは17%でした.
- 血圧を130mmHg以下またはLDL- Cを30%低下させると,10年間の心臓病のリスクはそれぞれ3. 7%と2. 7%減少する.
結論:
- 個々の修正可能なCHDリスク要因は,控えめな予後効果があるが,人口レベルでの予防の可能性は大きい.
- SBPと非HDL-Cを制御すると,全身疾患の発生率を大幅に減少させることができます.
- 危険因子評価の指標は,効果的なCHD予防のための特定の研究目標と整合する必要があります.
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